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Esophageal intramural pseudodiverticulosis is a rare disease characterized by multiple, flask-shaped outpouchings in the esophageal wall. These pseudodiverticula represent abnormally dilated excretory ducts of esophageal submucosal gland, which cause is unknown. The most common symptom is dysphagia associated with esophageal stricture. Frequently associated diseases were gastroesophageal reflux disease, diabetes mellitus, candida esophagitis, and chronic alcoholism. We have experienced a patient with dysphagia and anemia, who was diagnosed as esophageal stricture with intramural pseudodiverticulosis and pancreatic pseudoaneurysm. He was treated with esophageal bougienage for the esophageal stricture and transcatheter embolization for pancreatic pseudoaneurysm. This may be the first case of esophageal intramural pseudodiverticulosis reported in Korea. (Korean J Gastrointest Endosc 2002;24:285-290) 식도벽 내 가성게실증은 이제까지 약 200예 이하만이 보고된 드문 질환으로 수 mm 크기의 다발성의 낭성확장이 식도 내강으로부터 벽쪽으로 돌출된 가성게실을 특징으로 한다. 이러한 가성게실은 비정상적으로 확장된 점막하 점액선 분비관으로 밝혀져 있고 그 원인은 명확하지 않다. 주증상은 연하곤란이며 식도 협착이 흔히 동반된다. 저자들은 연하곤란과 빈혈을 주소로 내원하여 내시경 소견과 방사선 소견으로 식도 벽내 가성게실증으로 진단하고 식도 부우지 확장술을 시행하였고, 동반된 췌장 가성동맥류에 대해 경동맥 색전술로 치료한 1예를 경험하였다. 식도 벽내 가성게실증은 연하곤란 또는 식도 협착이 있는 환자에서 다른 원인이 없을 때 감별진단으로 고려해야 하며 동반된 식도 협착에 대한 치료는 내시경적 부우지 확장술이 일차 선택 치료이다.
Helicobacter pylori infection is associated with an increased risk of upper gastrointestinal diseases, such as peptic ulcer disease, gastric cancer, and mucosa associated lymphoid tissue lymphoma. Since 1998, when regimens for H. pylori eradication were first recommended in Korea, the triple therapy of proton pump inhibitor, clarithromycin, and amoxicillin has been recommended as a primary regimen. Recently updated Korean guideline also recommends standard triple therapy as first-line regimen. Several studies have suggested that the effectiveness of the standard triple therapy based on clarithromycin has decreased over time. A recent meta-analysis of first-line triple therapy in Korea showed that the eradication rate decreased significantly from 1998 to 2013 (P<0.001 for both intention-to-treat and per-protocol analyses. The overall eradication rate were 74.6% (95% CI, 72.1∼77.2%) by intention-to-treat analysis and 82.0% (95% CI, 80.8∼83.2%) by per-protocol analysis. Alternative regimens (non-bismuth quadruple therapy; sequential or concomitant therapy, bismuth quadruple therapy, or levofloxacin containing quadruple therapy) can be considered as first-line therapy for H. pylori infection in Korea. Nation-wide surveillance data on the resistance pattern is needed to recommend an effective first-line regimen in Korea.
<목적> 위식도 역류 질환의 진단에는 환자의 증상이 가장 중요하며 흉부작열감과 산 역류가 가장 중요한 증상으로 알려져 있으나, 흉부작열감에 대한 환자, 의사의 표현방법이 일정하지 않고, 일부 환자는 심와부 통증 또는 "쓰림" 증상으로 표현하기도 한다. 따라서 심와부에 국한된 통증 및 "쓰림" 증상을 주된 증상으로 호소하는 환자에서 위식도 역류질환의 유병률을 알아보고자 하였다. <방법> 2004년 9월부터 2005년 3월까지 전형적인 흉부작열감이나 산 역
Many reports have been published that provide epidemiological evidence supporting the efficacy of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) in cancer prevention. The presumed mechanism of chemoprevention is inhibition of cyclooxygenase (COX)-2. Aspirin exhibits an anticancerous effect through several inter-related mechanisms: prostaglandin synthesis and catabolism in epithelial cells, inhibition of Wnt-β‐catenin signaling, inactivation of platelets, and the host immune response. Several clinical studies have demonstrated that aspirin and NSAIDs exhibit chemopreventive effects in stomach cancer. However, well-designed clinical studies to answer critical clinical questions such as additional benefits of aspirin or NSAIDs after eradication of Helicobacter pylori, and the net benefit despite the adverse effects of long-term intake of aspirin or NSAIDs, are needed. (Korean J Helicobacter Up Gastrointest Res 2017;17:-174)
Endoscopic resection has become accepted as a standard treatment in selected patients with early gastric cancer (EGC) with negligible risk of lymph node metastasis. Endoscopic resection preserves the stomach and therefore improves quality of life compared with surgery. And it allows accurate histological staging of the tumor, which is critical in deciding whether additional treatment is necessary. The endoscopic submucosal dissection (ESD) method has been widely used with higher en bloc resection and complete resection rates than conventional endoscopic mucosal resection (EMR) with acceptable complication rates. Long-term clinical outcomes of these techniques are promising in terms of disease-free and overall survival. Recently, the expanded indication of endoscopic resection for early gastric cancer has been proposed because of technical advances of ESD. Long-term outcome data of the expanded indication are needed for the clinical application of the expanded criteria of ESD. (Korean J Med 2011;81:40-46)
The stomach is the most common primary site of an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type, which is characterized by an indolent clinical course. A diagnosis of gastric MALT lymphoma requires an endoscopic biopsy that should be confirmed by an experienced pathologist. Gastric MALT lymphoma shows a variable endoscopic appearance, including erosion, erythema, discoloration, atrophy, ulcer, and subepithelial lesion. The distribution is often multifocal. Therefore, clinical suspicion and multiple biopsies are essential for an accurate diagnosis. Gastric MALT lymphoma is almost invariably associated with a Helicobacter pylori (H. pylori) infection. H. pylori eradication therapy is the mainstay of treatment, which must be delivered to all patients regardless of the H. pylori infection status or stage. For patients who have failed to achieve remission following eradication therapy, radiotherapy or chemotherapy can be considered. Radiotherapy is an effective treatment modality for a localized stage and shows excellent outcomes. In the presence of disseminated or advanced disease, chemotherapy and/or immunotherapy with the anti-CD20 monoclonal antibody, rituximab, can be applied. Treatment should be individualized according to the stage and symptoms, as well as the patients’ preference. Given that the clinical course of gastric MALT lymphoma is usually indolent, watchful waiting may be an adequate strategy in selected cases where scheduled follow-up is guaranteed.